Researchers affiliated with the French GORTEC (Radiotherapy Oncology Group for Head and Neck) 2000-01 trial have reported that an induction regimen of Taxotere (docetaxel), Platinol® (cisplatin) and 5-FU (TPF) was superior to an induction regimen of Platinol and 5-FU (PF) for patients with advanced (stage III-IV) laryngeal and hypopharyngeal cancer. The results of this randomized trial were presented at the June 2006 meeting of the American Society of Clinical Oncology.

The treatment goal for stage III and IV cancer of the larynx is preservation of the larynx without jeopardizing survival. Stage III cancer has not spread outside of the larynx, but the vocal cords cannot move normally, or the cancer has spread to tissues next to the larynx, or the cancer has spread to one lymph node on the same side of the neck as the cancer and the lymph node measures no more than 3 centimeters. In stage IV, cancer has spread to tissues around the larynx, such as the pharynx or the tissues in the neck. The lymph nodes may or may not contain cancer. The cancer has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimeters.

Patients with stage III and some patients with stage IV are considered surgically resectable and have been treated by radical surgery and postoperative radiation therapy, resulting in the total ablation of the larynx. Alternatively, stage III and stage IV patients are initially treated with radiation therapy and radical surgery is reserved for salvage. More recently, chemotherapy has been used before and during radiation therapy, which suggest that the current optimal treatment for resectable stage III-IV laryngeal cancer is concomitant chemotherapy and radiotherapy with reservation of surgery for salvage treatment.

The current study randomized 108 patients to PF and 112 to TPF. Overall response for TPF was 83% compared to 61% for PF (p=0·0013). Complete or partial responders who recovered normal laryngeal mobility received radiotherapy. Non-responders had total laryngectomy and radiotherapy. The 3-year actuarial larynx preservation was 73% for the TPF group and 63% for the PF group at median follow-up of 35 months. There were trends for improved overall survival and disease-free survival in the TPF group. There were no differences in distant metastases between the two arms. There were also no differences in toxicity between the two arms. These authors concluded that TPF was associated with an increased response rate and an increased rate of larynx preservation compared to PF.

Comments:  This study suggests that progress is being made in developing chemotherapy regimens which allow for preservation of laryngeal function.

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Reference: Calais G, Pointreau M, Alfonsi C, et al. Randomized phase III trial comparing induction chemotherapy using cisplatin (P) fluorouracil (F) with or without docetaxel (T) for organ preservation in hypopharynx and larynx cancer. Preliminary results of GORTEC 2000-01. Journal of Clinical Oncology. 2006;24:abstract # 5506.